- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Lumbar paraspinal muscles (LPM) are a part of the deep spinal stabilisation system and play an important role in stabilising the lumbar spine and trunk. Inadequate function of these muscles is thought to be an essential aetiological factor in low back pain, and several neuromuscular diseases are characterised by dysfunction of LPM. The main aims of our study were to develop a methodology for LPM assessment using advanced magnetic resonance imaging (MRI) methods, including a manual segmentation process, to confirm the measurement reliability, to evaluate the LPM morphological parameters [fat fraction (FF), total muscle volume (TMV) and functional muscle volume (FMV)] in a healthy population, to study the influence of physiological factors on muscle morphology, and to build equations to predict LPM morphological parameters in a healthy population. METHODS: This prospective cross-sectional observational comparative single-centre study was conducted at the University Hospital in Brno, enrolling healthy volunteers from April 2021 to March 2023. MRI of the lumbar spine and LPM (erector spinae muscle and multifidus muscle) were performed using a 6-point Dixon gradient echo sequence. The segmentation of the LPM and the control muscle (psoas muscle) was done manually to obtain FF and TMV in a range from Th12/L1 to L5/S1. Intra-rater and inter-rater reliability were evaluated. Linear regression models were constructed to assess the effect of physiological factors on muscle FF, TMV and FMV. RESULTS: We enrolled 90 healthy volunteers (median age 38 years, 45 men). The creation of segmentation masks and the assessment of FF and TMV proved reliable (Dice coefficient 84% to 99%, intraclass correlation coefficient ≥0.97). The univariable models showed that FF of LPM was influenced the most by age (39.6% to 44.8% of variability, P<0.001); TMV and FMV by subject weight (34.9% to 67.6% of variability, P<0.001) and sex (24.7% to 64.1% of variability, P<0.001). Multivariable linear regression models for FF of LPM included age, body mass index and sex, with R-squared values ranging from 45.4% to 51.1%. Models for volumes of LPM included weight, age and sex, with R-squared values ranged from 37.4% to 76.8%. Equations were developed to calculate predicted FF, TMV and FMV for each muscle. CONCLUSIONS: A reliable methodology has been developed to assess the morphological parameters (biomarkers) of the LPM. The morphological parameters of the LPM are significantly influenced by physiological factors. Equations were constructed to calculate the predicted FF, TMV and FMV of individual muscles in relation to anthropometric parameters, age, and sex. This study, which presented LPM assessment methodology and predicted values of LPM morphological parameters in a healthy population, could improve our understanding of diseases involving LPM (low back pain and some neuromuscular diseases).
- Publikační typ
- časopisecké články MeSH
Home-based exercises have been on the rise recently. This pilot study aimed to assess the adherence and effect of a home-based rehabilitation programme using telemonitoring in patients with chronic non-specific low back pain (CNLBP). Twenty-seven patients with CNLBP were enrolled in the study, each of whom underwent a neurological assessment, including patient-oriented measures and a functional assessment-a battery of tests that comprehensively evaluated trunk muscle function. The rehabilitation programme lasted 18 weeks and included daily home-based exercises. A mobile application or an exercise diary was used to monitor compliance. Adherence to the programme was excellent for both the diary and mobile application groups, with 82.3% in the diary group exercising at least once a day and 72.9% twice a day, and 94.8% in the mobile application group exercising at least once a day and 86.6% twice a day. Both patient-oriented and functional outcomes improved significantly; however, the relative changes of the parameters in these two groups did not correlate, which supports the idea that trunk muscle function does not directly relate to patient complaints and that CNLBP is a multifactorial issue. This model of rehabilitation programme should be used in clinical practice, as its adherence and effectiveness seem noticeable.
- MeSH
- chronická bolest * MeSH
- lidé MeSH
- lumbalgie * rehabilitace MeSH
- pilotní projekty MeSH
- techniky fyzikální terapie MeSH
- terapie cvičením MeSH
- trup MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Lumbosacral plexopathy caused by radiotherapy is a rare but severe consequence of cancer treatment. This condition often leads to varying degrees of sensory and motor impairment. Neurological complications, which are typically permanent, manifest a long period after irradiation. CASE PRESENTATION: We describe a case of progressive lower extremity weakness and sensory impairment in a woman who had been effectively treated with radiotherapy for cervical cancer with development 36 years after irradiation. The electrophysiological assessment revealed a subacute bilateral axonal lesion of the lumbosacral plexus. None of the clinical manifestations, serology, cerebrospinal fluid or imaging data discovered an explanation other than radiation-induced lumbosacral plexopathy (RILP). CONCLUSIONS: This case demonstrates that RILP may emerge more than 30 years after the radiotherapy.
- MeSH
- diagnostické zobrazování MeSH
- lidé MeSH
- nádory děložního čípku * radioterapie patologie MeSH
- plexus lumbosacralis patologie MeSH
- polytrauma * patologie MeSH
- radiační poranění * etiologie patologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Úvod: Neuropatická bolest je častým klinickým projevem řady neurologických onemocnění. Klíčovou součástí jejího diagnostického algoritmu jsou jednoduché dotazníkové nástroje založené na přítomnosti typických popisných charakteristik (tzv. deskriptorů). Cíle: Cílem studie byla validace českých jazykových verzí dvou nejčastěji užívaných jednoduchých screeningových dotazníkových nástrojů zaměřených na neexpertní diagnostiku neuropatické bolesti, tj. dotazníků DN4cz (Douleur Neuropathique en 4 Questions) a PDQcz (painDetect). Soubor a metodika: Po jazykové validaci českých verzí obou dotazníků byly tyto následně administrovány skupině pacientů s periferní neuropatickou bolestí při polyneuropatii diabetické či jiné etiologie (n = 65) a skupině nemocných s nociceptivní bolestí v důsledku pokročilé artrózy kyčelního nebo kolenního kloubu nebo chronických vertebrogenních potíží (n = 74). Výsledky: Oba dotazníky prokázaly vynikající srozumitelnost a snadnou použitelnost. Pacienti s neuropatickou bolestí dosahovali významně vyšších dílčích i celkových skóre obou dotazníků ve srovnání s pacienty s bolestí nociceptivní. ROC analýza potvrdila vynikající diagnostickou validitu obou dotazníků v odlišení neuropatické a nociceptivní bolesti. Dotazník PDQcz však dosahoval významně lepší diagnostické validity při nižším než doporučeném cut-off. Závěr: České verze dotazníků DN4 a PDQ prokázaly vynikající diagnostickou validitu v odlišení neuropatické a nociceptivní bolesti a lze je doporučit pro neexpertní diagnostiku neuropatické bolesti. Diagnostická validita dotazníku PDQ je vyšší při použití nižšího cut-off.
Background: Neuropathic pain is a frequent vlinical manifestation of many neurological disorders. Simple questionnaires mainly based on the presence of so called “neuropathic pain descriptors” represent the most important screening tool in the diagnosis of this condition. Aim: The aim of this study was to validate the Czech language version of two most frequently used questionnaires focused on neuropathic pain diagnosis by non-specialists, i.e., Douleur Neuropathique en 4 Questions (DN4cz) and painDetect (PDQcz). Patients and methods: Initially, the language validation of both questionnaires was performed. In the next step, two groups of patients were examined using these Czech language versions of both questionnaires: a group of patients suffering from peripheral neuropathic pain (in diabetic polyneuropathy or polyneuropathies of other etiology) (N = 65), and a group of individuals with nociceptive pain due to severe coxarthrosis or gonarthrosis or chronic low back pain (N = 74). Results: Both questionnaires proved to be easy-to-use and understandable. The patients with neuropathic pain reached significantly higher both partial and overall scores in both questionnaires compared to nociceptive pain patients. ROC analysis confirmed an excellent diagnostic validity of both questionnaires in the discrimination between neuropathic and nociceptive pain. However, the optimal cut-off with the highest possible diagnostic validity for the PDQcz was found significantly lower than had been recommended. Conclusions: The Czech language versions of both DN4 and PDQ questionnaires proved excellent diagnostic validity in the discrimination of neuropathic and nociceptive pain. Both of them thus can be recommended as easy and useful tools for diagnosis of neuropathic pain by non-specialists. To reach optimal diagnostic validity, the cut-off of the PDQ should be set lower than had been previously recommended.
